This study is usually performed as an outpatient procedure and no specific patient preparation is required. The only absolute contraindication is a previous history of contrast allergy.
• Two 19-22 G butterfly needles are inserted into the corpora. Care must be taken to avoid perforation of the urethra
• An erection is induced by an intracorporeal injection of 1020 |g of prostaglandin Ej
• One of the needles is used to record intracavernosal pressures. A record is made of any increase in pressure up to the maximum pressure and the time taken to achieve it. A normal response is indicated by the intracavernosal pressure approaching mean arterial blood pressure within 5-10 minutes. Failure to do so may either be due to impaired inflow or increased outflow
• If after 10 minutes, there is no erection or the pressure is <80 mmHg, an infusion of saline (100-200 mL/min) is commenced via the other needle
• Erection should be achieved within 3 minutes; if not, the procedure should be concluded due to risks of local edema and systemic fluid overload
• A record is kept of the rate of infusion required to attain a full erection (normally less than 120 mL/min)
• Once a full erection is reached, the infusion is stopped and a note made of the rate of pressure drop. In normal patients this should be less than 1.5 mmHg and a rapid decline is indicative of a venous leak. The saline infusion can also be slowly recommenced to produce a flow adequate to maintain a full erection. Maintenance flow rates of >15 mL/s are suggestive of a venous leak. If a venous leak is suggested, cavernosography is performed
• A contrast media (60-100 mL of Omnipaque or urograffin) is infused slowly to obtain a pressure in the penis of 90 mmHg, which is physiologic pressure
• If the penis is not erect, contrast leakage into the veins is inevitable and therefore a full erection is mandatory
• Dynamic fluoroscopy should include AP and right and left oblique views. Under normal circumstances, no contrast should be visualized outside the two, near-straight corpora cavernosa (see Fig 3.11a,b). Any areas of contrast leakage or significant curvature are abnormal
• On completion of the study, the needles are removed to allow resolution of the erection
• The patient is also advised to squeeze the penis for 5 min to ensure complete emptying. Rarely, a priapism may occur, requiring incremental doses of ephedrine to accomplish detumescence
Pathological venous leakage is demonstrated by contrast in the superficial or deep dorsal veins, cavernosal veins and crural veins (in increasing degrees of clinical significance).
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